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      Lipoma de la mano, clínica y quirúrgicamente un tumor menospreciado Translated title: Hand lipoma, surgical and clinically an understimated tumor

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          Abstract

          Los lipomas suponen el 16 % de los tumores de tejidos blandos que se originan en la mano. Tienen una presentación clínica particular debido a la complejidad anatomofuncional de la zona. Analizamos 14 pacientes con diagnóstico clínico de lipoma en mano, 64.3 % de ellos de sexo femenino, con edad promedio de 44.1 años. La localización fue: en la vaina flexora digital 33.3 %, medio palmar (musculatura tenar principalmente) 40 %, muñeca dorsal (incluido interóseo) 20 % y antebraquial 6.7 %. La disminución de la función de la mano y/o de la muñeca fue la principal sintomatología de los pacientes (66.7 %). Las alteraciones funcionales producidas incluyeron: dedo en gatillo, alteraciones de la flexión y de la pinza, seguidos de dolor en 26.7 % y alteraciones de la sensibilidad en 26.7 %. Síndrome de túnel del carpo en 20 %. En 26.7 % la queja fue cosmética. La escisión resolvió la sintomatología en todos los casos. El seguimiento promedio fue de 15.8 meses, sin ningún caso de recurrencia y solamente se presentó una complicación menor. El estudio por imagen solo fue necesario en 1 caso de esta serie; la certeza mediante diagnóstico clínico fue del 93 %.

          Translated abstract

          Lipomas account for the 16 % of all the soft tissue hand tumors. Their clinical presentation is particular, due to the anatomical and functional complexity of the hand. We analyze 14 patients with the clinical diagnosis of hand lipoma, 64.3 % female, with medium age 44.1 years old. The localization was: digital flexor sheath 33.3 %, midpalmar (thenar muscles mainly) 40 %, dorsal wrist (including interosseus muscle) 20 % and antebrachial 6.7 %. The decrease in hand or wrist function was the main symptom (66.7 %). The functional impairments include: trigger finger, flexion and grip impairment, followed by pain, sensitivity alterations and cosmesis in 26.7 %. The carpal tunnel syndrome presented in 20 %. The surgical excision solved the symptoms in all cases. The mean follow-up was 15.8 months. None recurrence was observed and only 1 minor complication presented. We used an image study to make the diagnosis in 1 case, having a clinical diagnosis accuracy of 93 %.

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          Most cited references24

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          Giant lipomatous tumours of the hand and forearm.

          This study examines the presentation, management and outcomes of a series of 10 patients with giant lipomatous tumours (defined as greater than 5 cm diameter) of the hand and forearm who presented to our orthopaedic oncology service. All patients underwent local staging and were discussed at our multidisciplinary tumour meeting prior to definitive surgery. In all cases, neurovascular structures required mobilization in order to excise the tumour. Seven of the tumours were benign lipomas and one was a neural fibrolipoma. The other two were well differentiated lipoma-like liposarcomas/atypical lipomatous tumours. Giant lipomas and well differentiated lipoma-like liposarcomas/atypical lipomatous tumours of the hand and forearm present infrequently and a multidisciplinary approach is recommended in the investigation and surgical management of these patients.
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            Classification of benign fatty tumours of the upper limb.

            In this paper, the authors offer a classification of benign fatty tumours of the upper limb. There are three histologically distinct types of fat cells: immature fat cells which give rise to lipoblastomas, mature brown fat cells which give rise to hibernomas and mature white fat cells which give rise to lipomas. Lipomas are the most common and they are sub-classified according to the anatomic site of fat cells into dermal, subcutaneous and sub-fascial lipomas; or tumours directly related to muscle, bone, synovium or nerve. Finally, the authors review 67 patients with benign fatty tumours of the upper limb and provide clinical examples of these tumours including their characteristic histological and radiological features.
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              Carpal tunnel syndrome and trigger wrist caused by a lipoma arising from flexor tenosynovium: a case report.

              We report on a patient with lipoma arising from flexor tenosynovium at the level of the wrist who had snapping of the middle finger and carpal tunnel syndrome. She was relieved of these symptoms after excising the lipoma.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid )
                0376-7892
                December 2011
                : 37
                : 4
                : 349-353
                Affiliations
                [1 ] Hospital General Dr. Manuel Gea González Mexico
                [2 ] Hospital General Dr. Manuel Gea González Mexico
                Article
                S0376-78922011000400006
                10.4321/s0376-78922011000400006
                496c1a8e-ca84-4de3-b71a-9b0e6e9a7f35

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                SURGERY

                Surgery
                Lipoma,Soft tissue tumor,Hand surgery,Tumor de tejidos blandos,Cirugía de la mano
                Surgery
                Lipoma, Soft tissue tumor, Hand surgery, Tumor de tejidos blandos, Cirugía de la mano

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